Tu Huakang, Sun Liping, Dong Xiao, Gong Yuehua, Xu Qian, Jing Jingjing, Long Qi, Flanders W Dana, Bostick Roberd M, Yuan Yuan
Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, Shenyang, Liaoning, 110001, China; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Molecules to Mankind Program, Laney Graduate School, Emory University, Atlanta, Georgia.
Int J Cancer. 2015 Jan 15;136(2):425-34. doi: 10.1002/ijc.29005. Epub 2014 Jun 19.
Effectively managing precancerous lesions is crucial to reducing the gastric cancer (GC) burden. We evaluated associations of temporal changes in multiple serological markers (pepsinogen I [PGI], PGII, PGI/II ratio, gastrin-17 and anti-Helicobacter pylori IgG) with risk for progression of gastric precancerous lesions. From 1997 to 2011, repeated esophagogastroduodenoscopies with gastric mucosal biopsies and blood sample collections were conducted on 2,039 participants (5,070 person-visits) in the Zhuanghe Gastric Diseases Screening Program, Liaoning, China. Serum biomarkers were measured using ELISA, and gastric biopsies were evaluated using standardized histologic criteria. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using generalized estimating equations for correlated binary outcomes. The ORs for progression of gastric conditions comparing those whose serum PGI, PGII, and anti-H. pylori IgG levels increased ≥ 50% relative to those whose decreased ≥ 50% were, respectively 1.67 (CI, 1.22-2.28), 1.80 (CI, 1.40-2.33) and 1.93 (CI, 1.48-2.52). The OR for those whose PGI/II ratio decreased ≥ 50% relative to those whose increased ≥ 50% was 1.40 (CI, 1.08-1.81), and for those whose PGII and anti-H. pylori IgG levels both increased ≥ 50% relative to those whose levels both decreased ≥ 50% the OR was 3.18 (CI, 2.05-4.93). Changes in gastrin-17 were not statistically significantly associated with progression. These findings suggest that temporal changes in serum PGI, PGII, PGI/II ratio, and anti-H. pylori IgG levels (especially PGII and anti-H. pylori IgG combined) may be useful for assessing and managing risk for progression of gastric precancerous lesions.
有效管理癌前病变对于减轻胃癌（GC）负担至关重要。我们评估了多种血清学标志物（胃蛋白酶原I [PGI]、PGII、PGI/II比值、胃泌素-17和抗幽门螺杆菌IgG）的时间变化与胃癌前病变进展风险之间的关联。1997年至2011年期间，在中国辽宁省庄河胃癌筛查项目中，对2039名参与者（5070人次就诊）进行了重复的食管胃十二指肠镜检查及胃黏膜活检和血样采集。使用酶联免疫吸附测定法（ELISA）检测血清生物标志物，并根据标准化组织学标准评估胃活检结果。使用广义估计方程对相关二元结局估计比值比（OR）和95%置信区间（CI）。与血清PGI、PGII和抗幽门螺杆菌IgG水平下降≥50%的人相比，血清PGI、PGII和抗幽门螺杆菌IgG水平升高≥50%的人胃病变进展的OR分别为1.67（CI，1.22 - 2.28）、1.80（CI，1.40 - 2.33）和1.93（CI，1.48 - 2.52）。与PGI/II比值升高≥50%的人相比，PGI/II比值下降≥50%的人的OR为1.40（CI，1.08 - 1.81），与PGII和抗幽门螺杆菌IgG水平均下降≥50%的人相比，PGII和抗幽门螺杆菌IgG水平均升高≥50%的人的OR为3.18（CI，2.05 - 4.93）。胃泌素-17的变化与进展无统计学显著关联。这些发现表明，血清PGI、PGII、PGI/II比值和抗幽门螺杆菌IgG水平的时间变化（尤其是PGII和抗幽门螺杆菌IgG联合变化）可能有助于评估和管理胃癌前病变进展风险。
